METHODS: A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5% per annum were utilized. Scenario, deterministic and probabilistic sensitivity analyses were performed. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per quality-adjusted life year (QALY) gained.
RESULTS: For the base case scenario, TIRADS dominated the ATA2015 strategy by a slim margin, producing 0.005 more QALYs at $25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time.
CONCLUSIONS: The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules.
方法:使用决策树建模进行了成本效用分析,评估甲状腺偶发结节<4cm的成人患者。使用已发布的文献填充模型输入,观测数据,和专家意见。单一付款人视角,加拿大元货币,五年的时间范围,支付意愿(WTP)门槛为50,000美元,贴现率为每年1.5%。Scenario,进行了确定性和概率敏感性分析.主要结果是增量成本效益比(ICER),表示为获得的每质量调整生命年(QALY)的增量成本。
结果:对于基本情况,TIRADS以微弱优势主导了ATA2015战略,以25美元的成本生产0.005个以上的QALY。结果对活检的恶性率以及患有良性结节/亚临床恶性肿瘤或在监视下的患者的效用敏感。概率敏感性分析显示,在79.7%的情况下,TIRADS是更具成本效益的选择。
结论:与ATA2015相比,在大多数情况下,TIRADS指南可能是更具成本效益的策略,用于对偶然的甲状腺结节进行风险分层。